Excessive antibiotics use fuelling antimicrobial resistance – Physicians

According to the World Health Organisation, antimicrobial resistance occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.

The UN agency disclosed that as a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat.

In an interview with PUNCH HealthWise, a consultant paediatrician at Gbagada General Hospital, Lagos, Dr. Emokpae Abieyuwa relived his daily experience with children diagnosed with different ailments.

“I think the problem here is excessive use of antibiotics for viral infection. The most common are using antibiotics for a common cold or sore throat, inadequate dosing especially in children and not taking drugs for the expected duration (stopping medication after five days instead of prescribed 10 days).”

Warning the public to desist from irrational use of antibiotics, the paediatrician said that taking antibiotics for colds and cough or for non-bacterial diseases was a red flag.

When asked why global drug manufacturers have not been churning out novel antibiotics to replace old ones that have become resistant to bacteria over the years, Abieyuwa described it as an expensive innovation most pharmaceutical companies are unwilling to fund.

“It is a difficult venture as most pharmaceutical companies are more interested in producing drugs for chronic diseases such as hypertension and diabetes,” he said.

The immediate past chairman of the Association of General and Private Medical Practitioners of Nigeria, Lagos chapter, Dr. Tunji Akintade, however, stressed that it was a lot cheaper to engage in preventive measure than curative.

“Nigerians can buy perfume to flaunt but would rather price their health. Get proper consultation, diagnosis and appropriate treatment. It simply means you should see a doctor, who would send for relevant laboratory test to confirm the diagnosis and recommend a prescription from the pharmacy for you. Any tilt in this process is what has led us to the chaotic indices we are experiencing today.”

He also charged the government to criminalise drug abuse by arresting offenders, legislate against countries bringing in substandard drugs and properly fund health insurance, noting that the cost of health is not cheap.

“We can only continue to hope for the best. Science cannot be tired of research. Synthetic and isomer of old drugs are a possibility but it comes with time and cost. Unfortunately, we don’t have the time. At the end of the day, prevention is still better than cure,” he said.

New antibiotic discovery to gulp N672 billion

A recent New York Times’ analysis emphasized that undertaking research to develop a new antibiotic can cost $2.6 billion (about N672 billion in local currency) and the biggest part of that cost is the failures along the way.

“Coming up with new compounds is no easy feat. Only two new classes of antibiotics have been introduced in the last 20 years — most new drugs are variations on existing ones — and the diminishing financial returns have driven most companies from the market. In the 1980s, there were 18 major international pharmaceutical companies developing new antibiotics; today there are three,” the report says.

In a related event, Kingsley Ekwunife, deputy director of Pharmacy, National Orthopaedic Hospital, Igbobi, Lagos has expressed worry that antimicrobial drug-resistant was becoming a very big problem in Nigeria.

He noted that antibiotics have been long abused in the country, leading to the level of resistance being experienced today.

“In the past, we have superbugs that were curable. Suddenly these same antibiotics cannot take care of them anymore. It is quite challenging. The post-antibiotics era is fast approaching, a situation where the antibiotics used in the past can no longer be used to treat a simple ailment. That is a disaster.

“The most accessible healthcare professionals open to patient-oriented care are strategically positioned. We, as pharmacists, have a duty position to educate the patients on how to use antibiotics according to prescription,” he declared.

Ekwunife lamented that the influx of quacks and non-pharmacist in the pharmaceutical industry has further fuelled the perennial problem of drugs mishandling in society.

“Today, so many people are into commercial vending of drugs. We have heard stories about how they go about cutting antibiotics like Ampiclox into smaller sachets for some uninformed patients to use. This is how some of these drugs often lead to resistance.

“The government needs to up its game. We pharmacists also have a duty to educate our patients on the need to avoid resorting to antibiotics without doctor’s prescription and laboratory investigation. This is because new molecules are no longer being discovered,” he said.


Only one antibiotic discovery in 30 years

According to the pharmacist, most reputable international companies are no longer discovering or inventing new antibiotics, adding that only one antibiotic – Teiobactam was discovered in the past 30 years.

“The truth of the matter is that a lot of investment is needed for the discovery of new drugs. By the time investors pumped in millions of dollars, how many of these antibiotics is formed? After 10 years, the patent expires and you find its generics all over the place. In most cases, these investors don’t even recoup the fund invested. It means their investment is wasted.

“At this stage, all of us are exposed to these antibiotics drug resistance whether we are the one abusing it or not. There is still a need for massive awareness on the part of the public. On our part, as pharmacists, we shall continue to educate them on the danger of antibiotics resistance. This idea of cutting antibiotics to use for two or three days is undesirable. Even where the physician prescribes the drugs, patients don’t often complete the full course or dosage just because they feel a temporary sense of relief.”